Healthcare Provider Details

I. General information

NPI: 1699493601
Provider Name (Legal Business Name): CHELSEA GILLISPIE PARDUE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 ELECTRIC RD
ROANOKE VA
24018-3551
US

IV. Provider business mailing address

9595 AIRPOINT DR
BENT MOUNTAIN VA
24059-2007
US

V. Phone/Fax

Practice location:
  • Phone: 540-772-5140
  • Fax:
Mailing address:
  • Phone: 540-493-3390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904013691
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: